中华烧伤杂志
中華燒傷雜誌
중화소상잡지
16
2015年
3期
172-176
,共5页
侯春胜%刘庆叶%郝红飞%董玉莹%王峰%雷晋
侯春勝%劉慶葉%郝紅飛%董玉瑩%王峰%雷晉
후춘성%류경협%학홍비%동옥형%왕봉%뢰진
烧伤%瘢痕%手%牵引术%掌骨%指骨
燒傷%瘢痕%手%牽引術%掌骨%指骨
소상%반흔%수%견인술%장골%지골
Burns%Cicatrix%Hand%Traction%Metacarpus%Finger phalanges
目的 回顾性分析掌骨指骨牵引矫治手掌侧烧伤后瘢痕挛缩的效果. 方法 2010年5月-2014年12月,笔者单位收治手掌侧烧伤后瘢痕挛缩患者32例共39只手.治疗方法:瘢痕保守松解植皮,简称A方法;在挛缩手指中远节指骨与对应掌骨问呈U形留置克氏针牵引2～7周,简称B方法;在第2～5掌骨、挛缩手指远端指骨留置克氏针形成牵引桩、牵引锚的基础上构建牵引架,用橡皮筋将手指向拉长、伸直位牵引2～6个月,简称C方法.对传统需行瘢痕彻底松解植皮者改行A方法,对松解植皮后既往需行髓内克氏针固定者改行B方法,尚不能达到预期目标者加行C方法;对瘢痕松解可能导致血运障碍或肌腱及骨外露者,先行C方法再行A方法,不能达到预期目标者加行C方法;对不愿行植皮术者仅行C方法.治疗期间,观察术区有无感染、克氏针有无滑动及对组织有无切割等;治疗结束后1～2周,观察瘢痕挛缩有无复发倾向;治疗前、治疗结束时、治疗结束后1个月,测量各挛缩手指末端至腕横纹的掌侧皮肤长度;治疗前及治疗结束后1、3、6个月,采用温哥华瘢痕评定量表进行瘢痕情况评分;治疗前、治疗结束后1个月,采用总主动活动度(TAM)法评定关节活动度,采用Jebsen手功能测试法评定手功能并记录完成测试时间.对数据行方差分析、LSD-t检验、t检验. 结果 24例患者27只手采用A+B方案,5例患者7只手仅行C方法,2例患者3只手采用A+B+C方案,l例患者2只手采用C+A+C方案.治疗期间未见术区感染、组织切割等并发症,13例患者14只手U形克氏针轻微滑动;10例患者11只手瘢痕挛缩有复发倾向,经支具治疗未复发.治疗结束时、治疗结束后1个月,手掌侧皮肤长度分别为(131.8±9.8)、(127.6±7.5)mm,显著长于治疗前的(114.5±2.4) mm(t值分别为10.71、10.39,P值均小于0.001).治疗前及治疗结束后1、3、6个月瘢痕情况评分分别为(9.8±2.4)、(9.7±1.7)、(9.3±0.8)、(7.7±0.5)分,仅治疗结束后6个月评分显著低于治疗前(t=3.28,P＜0.01).治疗前与治疗结束后1个月,TAM评定优良比分别为2.6％ (1/39)、94.9％ (37/39).治疗前完成手功能测试时间为(13.9 ±4.1)min,治疗结束后1个月显著缩短为(11.0 ±2.8)min(t=3.65,P＜0.001). 结论 掌骨指骨牵引单独应用或与瘢痕松解植皮联合矫治手掌侧烧伤后瘢痕挛缩,均可使挛缩组织蠕变延长,利于手功能及外形恢复.
目的 迴顧性分析掌骨指骨牽引矯治手掌側燒傷後瘢痕攣縮的效果. 方法 2010年5月-2014年12月,筆者單位收治手掌側燒傷後瘢痕攣縮患者32例共39隻手.治療方法:瘢痕保守鬆解植皮,簡稱A方法;在攣縮手指中遠節指骨與對應掌骨問呈U形留置剋氏針牽引2～7週,簡稱B方法;在第2～5掌骨、攣縮手指遠耑指骨留置剋氏針形成牽引樁、牽引錨的基礎上構建牽引架,用橡皮觔將手指嚮拉長、伸直位牽引2～6箇月,簡稱C方法.對傳統需行瘢痕徹底鬆解植皮者改行A方法,對鬆解植皮後既往需行髓內剋氏針固定者改行B方法,尚不能達到預期目標者加行C方法;對瘢痕鬆解可能導緻血運障礙或肌腱及骨外露者,先行C方法再行A方法,不能達到預期目標者加行C方法;對不願行植皮術者僅行C方法.治療期間,觀察術區有無感染、剋氏針有無滑動及對組織有無切割等;治療結束後1～2週,觀察瘢痕攣縮有無複髮傾嚮;治療前、治療結束時、治療結束後1箇月,測量各攣縮手指末耑至腕橫紋的掌側皮膚長度;治療前及治療結束後1、3、6箇月,採用溫哥華瘢痕評定量錶進行瘢痕情況評分;治療前、治療結束後1箇月,採用總主動活動度(TAM)法評定關節活動度,採用Jebsen手功能測試法評定手功能併記錄完成測試時間.對數據行方差分析、LSD-t檢驗、t檢驗. 結果 24例患者27隻手採用A+B方案,5例患者7隻手僅行C方法,2例患者3隻手採用A+B+C方案,l例患者2隻手採用C+A+C方案.治療期間未見術區感染、組織切割等併髮癥,13例患者14隻手U形剋氏針輕微滑動;10例患者11隻手瘢痕攣縮有複髮傾嚮,經支具治療未複髮.治療結束時、治療結束後1箇月,手掌側皮膚長度分彆為(131.8±9.8)、(127.6±7.5)mm,顯著長于治療前的(114.5±2.4) mm(t值分彆為10.71、10.39,P值均小于0.001).治療前及治療結束後1、3、6箇月瘢痕情況評分分彆為(9.8±2.4)、(9.7±1.7)、(9.3±0.8)、(7.7±0.5)分,僅治療結束後6箇月評分顯著低于治療前(t=3.28,P＜0.01).治療前與治療結束後1箇月,TAM評定優良比分彆為2.6％ (1/39)、94.9％ (37/39).治療前完成手功能測試時間為(13.9 ±4.1)min,治療結束後1箇月顯著縮短為(11.0 ±2.8)min(t=3.65,P＜0.001). 結論 掌骨指骨牽引單獨應用或與瘢痕鬆解植皮聯閤矯治手掌側燒傷後瘢痕攣縮,均可使攣縮組織蠕變延長,利于手功能及外形恢複.
목적 회고성분석장골지골견인교치수장측소상후반흔련축적효과. 방법 2010년5월-2014년12월,필자단위수치수장측소상후반흔련축환자32례공39지수.치료방법:반흔보수송해식피,간칭A방법;재련축수지중원절지골여대응장골문정U형류치극씨침견인2～7주,간칭B방법;재제2～5장골、련축수지원단지골류치극씨침형성견인장、견인묘적기출상구건견인가,용상피근장수지향랍장、신직위견인2～6개월,간칭C방법.대전통수행반흔철저송해식피자개행A방법,대송해식피후기왕수행수내극씨침고정자개행B방법,상불능체도예기목표자가행C방법;대반흔송해가능도치혈운장애혹기건급골외로자,선행C방법재행A방법,불능체도예기목표자가행C방법;대불원행식피술자부행C방법.치료기간,관찰술구유무감염、극씨침유무활동급대조직유무절할등;치료결속후1～2주,관찰반흔련축유무복발경향;치료전、치료결속시、치료결속후1개월,측량각련축수지말단지완횡문적장측피부장도;치료전급치료결속후1、3、6개월,채용온가화반흔평정량표진행반흔정황평분;치료전、치료결속후1개월,채용총주동활동도(TAM)법평정관절활동도,채용Jebsen수공능측시법평정수공능병기록완성측시시간.대수거행방차분석、LSD-t검험、t검험. 결과 24례환자27지수채용A+B방안,5례환자7지수부행C방법,2례환자3지수채용A+B+C방안,l례환자2지수채용C+A+C방안.치료기간미견술구감염、조직절할등병발증,13례환자14지수U형극씨침경미활동;10례환자11지수반흔련축유복발경향,경지구치료미복발.치료결속시、치료결속후1개월,수장측피부장도분별위(131.8±9.8)、(127.6±7.5)mm,현저장우치료전적(114.5±2.4) mm(t치분별위10.71、10.39,P치균소우0.001).치료전급치료결속후1、3、6개월반흔정황평분분별위(9.8±2.4)、(9.7±1.7)、(9.3±0.8)、(7.7±0.5)분,부치료결속후6개월평분현저저우치료전(t=3.28,P＜0.01).치료전여치료결속후1개월,TAM평정우량비분별위2.6％ (1/39)、94.9％ (37/39).치료전완성수공능측시시간위(13.9 ±4.1)min,치료결속후1개월현저축단위(11.0 ±2.8)min(t=3.65,P＜0.001). 결론 장골지골견인단독응용혹여반흔송해식피연합교치수장측소상후반흔련축,균가사련축조직연변연장,리우수공능급외형회복.
Objective To analyze the effects of metacarpus and phalanx traction on correction of scar contracture of hand after burn on the palm side retrospectively.Methods A total of 32 patients with 39 affected hands with scar contracture on the palm side after burn were hospitalized from May 2010 to December 2014.Method of treatment:scar contracture was conservatively released followed by skin grafting,which was referred to as method A;Kirschner wire was inserted into the middle or distal phalanx of finger with contracture and the corresponding metacarpus in the shape of U for 2 to 7 weeks' traction,which was referred to as method B;traction frame was built based on the traction pile and anchor formed by Kirschner wire inserted through the second to the fifth metacarpus and distal phalanx of finger with contraeture,and then the affected fingers were pulled into a straight position with rubber bands for 2 to 6 months,which was referred to as method C.Method A was used in patients who would be treated with thorough release of scar followed by skin grafting routinely.Method B was used in patients who would be treated with intramedullary Kirschner wire fixation after release of scar contracture and skin transplantation routinely.Method C was further used in patients when methods A and B failed to accomplish the expected result.Method C was used in the first place followed by method A in whom there might be vascular decompensation or exposure of tendon and bone after scar release,and those who failed to meet the expectation were treated with method C in addition.Patients who were unwilling to undergo surgery were treated with method C exclusively.During the course of treatment,the presence or absence of infection and slipping of Kirschner wire or its slitting through soft tissue were observed.The presence or absence of tendency of recurrence of scar contracture within 1 to 2 weeks after treatment was observed.The length of palmar skin measuring from the root of finger with contracture to wrist crease was measured before treatment,at the termination of treatment,and 1 month after the termination of treatment.Scar condition was assessed with the Vancouver Scar Scale (VSS) before treatment and 1,3,and 6 month (s) after the termination of treatment.Before treatment and 1 month after the termination of treatment,the range of motion was measured with the Total Active Movement (TAM) method;hand function was evaluated by the Jebsen Test of Hand Function (JTHF),and the completion time was recorded.Data were processed with analysis of variance,LSD-t test,and t test.Results Twenty-four patients with 27 affected hands were treated with scheme A + B;5 patients with 7 affected hands were treated with method C exclusively;2 patients with 3 affected hands were treated with scheme A + B + C;1 patient with 2 affected hands were treated with scheme C + A + C.During the course of treatment,no complication such as infection or slicing of tissue was observed,but there was a slight shifting of U-shaped Kirschner wire in 14 affected hands of 13 patients.Tendency of recurrence of scar contracture was observed in 11 affected hands of 10 patients,but the scar contracture did not reoccur after treatment with orthosis.The skin length of palmar side was respectively (131.8 ± 9.8) and (127.6 ± 7.5) mm at the termination of treatment and 1 month after,and they were both significantly longer than that before treatment [(114.5 ± 2.4) mm,with t values respectively 10.71 and 10.39,P values below 0.001].The score of VSS was respectively (9.8 ± 2.4),(9.7±1.7),(9.3-±0.8),and (7.7±0.5) points before treatment andl,3,and6month (s) after the termination of treatment.Only the score at 6 months after the termination of treatment was significantly lower than that before treatment (t =3.28,P ＜ 0.01).The ratio of excellent and good results according to method TAM was respectively 2.6％ (1/39) and 94.9％ (37/39) before treatment and 1 month after the termination of treatment.The time for JTHF measurement was (13.9 ±4.1) min before treatment,and it was shortened to (11.0 ±2.8) min 1 month after the termination of treatment (t =3.65,P ＜0.001).Conclusions Single application of metacarpus and phalanx traction or its combination with skin transplantation after scar release in correcting scar contracture of the palm of hand after burn can lengthen the contracted tissue,and it is beneficial for the restoration of function and appearance of affected hand.
